New Study Finds No Increased Risk from Female HRT

A study published a decade ago cast a cloud on female HRT by finding an increased risk of breast cancer in women treated with HRT versus placebo. Now a follow up study of the the same group analyzed in the original study finds no increased risk of death in those women treated with HRT, nor any increased risk of death from heart disease or cancer. The study was published in JAMA, and reported on in various news articles, such as this one in the LA Times.

The findings come from the Women’s Health Initiative’s hormone therapy trials, which were launched to assess the benefits and risks to mostly healthy post-menopausal women of taking hormone-replacement pills in a bid to reduce their risk of developing such cardiovascular and other chronic diseases. The study’s 27,347 subjects averaged about 63 years old when they joined the study.

The Women’s Health Initiative has been the source of a number of findings on the safety of hormone replacement therapy, many of them more perplexing than enlightening. In 2002 and 2004, its findings raised concerns that HRT would increase women’s risk of heart disease, stroke and breast cancer.

Those findings would eventually lead to safer hormone combinations and a better understanding of who should consider HRT and when it should be initiated. But they would also slow a gathering stampede of menopausal women toward HRT and discourage many who could benefit from the treatment from considering it.

The latest trial results compared the death rates of 13,531 women who were assigned to take a placebo treatment to those of menopausal women who got one of two different forms of hormone-replacement therapy: 8,506 women — mostly those with an intact uterus — were assigned to get a combination of estrogen and progestin, and 5,310 — most of whom had undergone hysterectomy — got estrogen alone. (For women with an intact uterus, progestin was widely added to HRT regimens in the 1980s and ’90s after researchers found that estrogen-alone regimens increased rates of endometrial cancers in such women.)

Over the trial’s 18 years of follow-up, 7,489 of the women died. But whether researchers looked at death-from-any-cause, or deaths due to cancer, heart disease or stroke, the distribution of deaths in the trial’s various arms showed no statistically significant differences.

I've always felt that part of the stigma around male HRT was due to the suspicion that it might prove as dangerous as female HRT. Now that the fears about female HRT have been relieved, more doctors may see that fears about male HRT are also groundless.